Definitions
Covered Illness means Diabetic Retinopathy, Diabetic Nephropathy, Diabetic Foot Ulcer
Diabetic Retinopathy means damage of retina of the eye caused by diabetes mellitius type II. This include Macularoedema, Non-Proliferative diabetic retinopathy & proliferative diabetic retinopathy, requiring restoration through laser procedure
Diabetic Nephropathy means uncontrolled diabetes mellitus type II, causing structural damages to the nephrons & tubules of both the kidney leading to micro & macro albuminuria, uremia developing into chronic renal failure necessitating peritoneal./haemodialysis, kidney transplantation
Diabetic Foot Ulcer means ulceration of the foot due to diabetes mellitus type II with or without external injury requiring micro vascular surgery
Pre-Existing disease/Condition in relation to each relevant person means Diabetic Retinopathy and/or Diabetic Nephropathy and/or Diabetic Foot Ulcer which existed prior to the date of commencement of the DIA-Card issue date or for which medical consultation was received or treatment was taken, hospitalization or surgery was undergone prior to the date of commencement of the DIA-Card scheme.
Panel of Doctors means doctors which are enrolled for consultation under the scheme
Affiliated Centers means hospitals/ nursing homes/ laboratories which has affiliation of MCRC to do the testing.
Exclusions
MCRC shall not be liable to make payments under this scheme in respect of any expenses what so ever incurred by an DIA-Card holder in connection with or in respect of
Treatment Of Cataract
Treatment of pre-existing disease/ conditions as defined
Any expenses towards treatment of diabetes Mellitus part II.
Any expenses towards immune suppressive drugs/medicines
Any expenses towards post-donation complications of the donor
Any expenses incurred towards the covered illness with 15 days from the commencement of the scheme
Cost of walkers, artificial limbs, crutches, wheel chairs & such other similar aids.
Charges incurred at hospital or nursing home primarily for diagnostic, X-ray or laboratory examinations not consisting with or incidental to the diagnosis and the treatment of the positive existence or presence of the covered illness for which the confinement is required at hospital/nursing home.
Expenses on vitamins & tonics unless forming part of the treatment for injury or disease as certified by the attending physician.
Naturopathy treatment
Hospital registration charges, record charges, telephone charges & such other charges
Expenses incurred for treatment of diseases / illness / accidental injuries by systems of medicines other than allopathic
Expenses incurred on cosmetic or aesthetic treatment of any description and/or plastic surgery even if necessitated following any of the covered illness/disease.
Conditions
Expenses incurred on cosmetic or aesthetic treatment of any description and/or plastic surgery even if necessitated following any of the covered illness/disease.
Doctor consultation is to be done through MCRC only. DIA-Card holder has to call up MCRC help line to fix up appointment to consult the Panel of doctors of MCRC
Under the DIA-Card scheme the card holder has to consult the panel of doctors appointed by MCRC once in three months
For receiving the claim, it is mandatory that DIA-Card holders has to consult the Panel of doctors once in three months with the blood check-up results as prescribed by panel of doctors. Any claims arisen without the proper consultation of the panel of doctors will not be considered.
MCRC shall not be liable to make any payment under the scheme in respect of any claim if such claim is in any manner fraudulent or supported by any fraudulent means or device, misrepresentation whether by the insured person or by any other person acting on this behalf
Any changes that is made on the scheme by MCRC shall be applicable to the DIA-Card holder from the next renewal date
The three member advisory board which is appointed by the MCRC foundations has the full authority to decide the authenticity of the claim and their decisions will be final for approving the amount
All claims under this policy shall be payable in Indian currency
Company liability is limited to the amount of Rs.50000/- per DIA-Card holder
Complaints in any case, the card holder may contact MCRC at the specified address, during the normal business hours.
Prior to admission at hospital for the claimable diseases, the card holder has to inform to MCRC, The date of admission, hospital name & doctors name on or before the date of admission
Claims & Settlements: Procedures for claim settlement
Letter from MCRC panel of doctors confirming the treatment.
Discharge Summary, Investigation report from hospital
Copy of acknowledgement slip received from consultant doctor every three months
Original copy of medicals bills
Reimbursement will be done within 15 days to the patient through cheque/DD from MCRC Foundations.